A proposal to combat growth of antibiotics-resistant superbugs

First, we need to price new antibiotics at a higher level that better reflects their value. Antibiotics are valuable to society, but reimbursed as if they were cheap and plentiful. Second, we need incentive-based policies that ensure that antibiotics are not oversold and their usefulness undermined. Under our proposal, payment for new antibiotics would be conditioned on meeting conservation and resistance targets set by the government. The CDC, for example, could use factors such as disease incidence and the rate of emerging resistance to set public health goals, which would then be re-assessed on a regular basis. If the observed data met the target, the manufacturer would maintain its marketing exclusivity. In other words, instead of being subject to the traditional patent period, the manufacturer would earn revenue on the drug by showing that careful marketing and infection-control activities had slowed the rate at which resistance had developed. […]

[S]ome new antibiotics are very valuable, but only a few patients with highly resistant diseases need them. We should use these antibiotics very sparingly today, saving them for later years when resistance is more widespread. But if we preserve these important new antibiotics for our children, companies complain that their sales are undercut. Why invest in R&D if the product can’t be sold to many people?

Under our proposal, outlined with help from the Extending the Cure project in the September issue of Health Affairs, developers of new antibiotics would be incentivized to support the end goal of reducing resistance, including a Strategic Antibiotic Reserve. Finally, we believe that pharmaceutical manufacturers would find it in their interest to provide needed resources to hospitals to adopt strict surveillance and infection-control protocols so that resistant organisms cannot easily jump from one place to the next.

This is attacking the wrong end of the problem. We can discover new antibiotics and price them higher (as if new antibiotics are not already overpriced) but this will not prevent their overuse and resistance. The incentives and protections in this proposal will be ineffective. We already conduct resistance surveillance and issue warnings and price new antibiotics at high levels. Pharma will game the system to increase their profits and ignore resistance.
This does nothing to address the abuse of antibiotics in farming which is the source of most resistance. These resistance genes are easily passed to organisms which infect humans. These resistance genes usually confer resistance to broad classes of antibiotics, not just a single molecule. The experience in Denmark has show that when farm use of antibiotics declines, resistance declines (one example: antibiotic resistant enterococci declined from 82% to 12% in three years after stopping antibiotic use in chickens).
Another example of futility of inventing new antibiotics:
“Synercid, for example, may become one of the only effective cures for deadly bloodstream infections. Although it has not yet been approved for use in humans, Synercid’s value already has been compromised because a related drug, virginiamycin, is fed to livestock. In the U.S., bacteria resistant to Synercid have been found in turkeys fed virginiamycin. In Germany, bacteria resistant to Synercid have been detected in humans even though the drug has not been given to people.”

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